Eur Heart J Acute Cardiovasc Care. 2025 Dec 22:zuaf165. doi: 10.1093/ehjacc/zuaf165. Online ahead of print.
ABSTRACT
BACKGROUND: Longer ischaemic time during ST-elevation myocardial infarction (STEMI) is associated with higher mortality. However, how prehospital delay time affects outcomes and has evolved over time remains unknown. The aims were to study prognostic impact of prehospital delay time in STEMI patients during two decades in Sweden, and to explore temporal trends and differences stratified by age, sex and presence of diabetes mellitus.
METHODS: Observational prospective cohort study based on the SWEDEHEART registry 1998-2017. Associations between prehospital delay time and 14-day, 1-year and 5-year mortality were estimated with Kaplan Meier and Cox regression analyses.
RESULTS: Among 89155 patients higher short- and long-term mortality was observed with increasing prehospital delay time. The multivariable adjusted risk of 14-days mortality increased approximately 2% per hour of delay (hazard ratio [HR] 1.018, 95% confidence interval [CI] 1.011-1.025), whereas the corresponding number for 1- and 5 year-mortality was 1% (HR 1.011, 95% CI 1.006-1.016 and HR 1.009, 95% CI 1.005-1.013, respectively). No significant trend of prehospital delay time during the 20 years was observed (median 150 minutes, interquartile range [IQR] 80-302), as the curve was hump-shaped. During the fibrinolytic era (1998-2004) prehospital delay time significantly increased while it decreased during the primary percutaneous coronary intervention (PPCI) era (2005-2017). Consistently prolonged prehospital delay times were shown in women, elderly (>70 years), and patients with diabetes with a delay 25-30 minutes longer than their counterparts.
CONCLUSIONS: Pre-hospital delay is an independent predictor of mortality. Whereas no declining trend was observed the last 20 years it is reassuring that a decrease of delay was found during the PPCI era. Women, elderly, and individuals with diabetes had consistently prolonged delay times and needs to be targeted in future interventions.
PMID:41428356 | DOI:10.1093/ehjacc/zuaf165